Abstract
Reflective supervision scaffolds a stronger supervisor working alliance (SWA), or supervisor–trainee relationship, which is critical to trainees’ skill development. Given supervisory trainings’ positive impact on these dynamics, and the increased need for access to these trainings, an asynchronous online training program for clinical supervisors was assessed to evaluate its impact on the SWA during social work and counseling field placements. Findings revealed supervisors’ satisfaction with the training, and improved SWA from pre- to posttest for both trainees and supervisors, with supervisors’ years of experience playing a unique role. This study supports the establishment and participation of supervisors in an asynchronous training program.
Keywords: clinical fieldwork; reflective supervision; working alliance; social work; counseling
Clinical supervision during fieldwork experiences is an essential component of professional development and gatekeeping in social work and counseling master’s degree programs (American Counseling Association [ACA], 2014; National Association of Social Workers [NASW], 2021). Supervisors report that the main goal for providing high-quality clinical supervision is ensuring that trainees conduct safe practice with clients, whereas trainees report wanting to develop trust, support, and a safe place in the supervision space (Pack, 2012). Through reflective supervision, a stronger supervision relationship, or working alliance, is fostered between the supervisor and the trainee (Watkins, 2015). A working alliance is conceptualized as a combination of the supervisor–supervisee relationship, supervision tasks, and supervisor functions (Vandette et al., 2021). Supervision training programs are one method to expand supervision skills postgraduation, which in turn benefits the trainee through improved preparation for practice. (Bennett et al., 2012; Davys et al., 2017; Herbert et al., 2014). This research study examines the effectiveness of a supervision training program on the supervisory working alliance for master’s-level social work and counseling students, as well as on the supervisors’ satisfaction with the supervision training program.
Reflective Supervision
Reflective supervision, which is especially helpful for novice professionals in counseling and social work (Franklin, 2011; Susman-Stillman et al., 2020), involves examining the processes within both the therapeutic relationship and the supervision relationship (Franklin, 2011). In addition to looking at the content of the therapy sessions, the underlying themes and experiences within the processes are explored (Franklin, 2011). Trainees report themes centered around emotional skills, reflective skills, stress-coping skills, and supportive relationships (Susman-Stillman et al., 2020). Reflective supervision leads to increased autonomy (Lawlor, 2013), self-efficacy, job satisfaction, ability to cope with stress and burnout (Frosh et al., 2018; Shea et al., 2020), and professional growth (Frosh et al., 2018) for trainees. Through reflective supervision, practicing student social workers and counselors are better able to understand their own mental states as well as those of their clients (Remez, 2016), including the dynamics among them. Tomlin and colleagues (2014) reported that supervisor qualities and behaviors, particularly those related to “safety and trust, respect, and sharing of attention, power, and the ‘journey’ within the relationship” (p. 77) are particularly instrumental in reflective supervision (Watkins, 2015). Reflective supervision helps to form the working relationship between supervisor and supervisee, to benefit professional growth, the supervisory relationship, and the therapeutic process.
Working Alliance
A strong working alliance between supervisor and trainee is instrumental in the development of therapeutic skills, particularly for new trainees (Gard & Lewis, 2008) and leads to more meaningful experiences during field placement (Sackett & Lawson, 2014). In addition to reflective supervision, the qualities and behaviors of the supervisor and trainee impact the working alliance (Watkins, 2015). Researchers have found that the working alliance is negatively impacted by trainee characteristics of maladaptive perfection (Ganske et al., 2015; Gnilka et al., 2016), anxious attachment, and stress (Gnilka et al., 2016). Although some characteristics may be difficult to ameliorate, these areas can be addressed during the supervision process. For instance, using coping skills (Gnilka et al., 2012), practicing mindfulness techniques (Johnson et al., 2018), and having self-efficacy (Ganske et al., 2015) have been found to be positively impactful on the working alliance. Additionally, the emotional intelligence of both supervisor and trainee (Cooper & Ng, 2009) as well as self-disclosure by the supervisor (Davidson, 2011) strengthen the supervisory relationship.
Bordin (1983) developed a working alliance–based model of supervision consisting of three facets: mutual agreements, tasks, and bonds. Mutual agreements involve working together to develop change goals for the supervision experience, with a focus on affect, behaviors, and cognitions. Tasks consist of the activities used to achieve the change goals that must be embraced by both supervisor and trainee, and include needed modifications when tasks are not successful. Bonds refer to the relationship that is formed through sharing and spending time with one another while developing rapport (Bordin, 1983). By utilizing these three components, the supervisory working alliance is formed and continues to evolve.
Efstation and colleagues (1990) operationalized the work of Bordin (1983) and others (e.g., Greenson, 1967) through the development of the Supervisory Working Alliance Inventory (SWAI). Through analyses, the researchers uncovered three factors from the supervisor SWAI form (client focus, rapport, and identification) and two factors from the trainee form (client focus and rapport) (Efstation et al., 1990). Client focus measures the degree to which the supervisory relationship is centered on the client; rapport describes the degree of beneficial communication during supervision; and identification measures the supervisor’s perception of how much the trainee relates professionally with the supervisor. The supervisory working alliance is measured by combining the sections for each inventory (Efstation et al., 1990).
The demographic information of the supervisor and trainee is often collected in research; however, there is a dearth of research examining the relationship of these variables within the supervisory working alliance (Park et al., 2019). Trainees of color may experience more marginalization and negative outcomes than White peers (Burkard et al., 2006), but the majority of research has focused on the experience of White trainees (Park et al., 2019). Years of experience of the supervisor is often measured and reported in detail (e.g., Vandette et al., 2021), but a review of the literature indicates that the relationship of this variable to the supervisory experience has not been investigated.
Supervision Training Programs
Training programs can contribute to improving not only the working alliance for both the supervisor and trainee (Bennett et al., 2012), but also clinical supervision knowledge for the supervisor (Herbert et al., 2014). Naturally, supervision training and development increases the supervisor’s focus on the trainee (Bright & Evans, 2019), self-efficacy (Neyland-Brown et al., 2019), and understanding of supervision models (Merlin-Knoblich et al., 2018). Supervisors and trainees indicate that resources and training are beneficial during the supervision and evaluation process (Davys et al., 2017). The structure of supervision training models can vary, comprising both traditional, in-person formats, and teletraining formats.
Supervision training programs can vary in length, format, and content. Most research has focused on in-person trainings that occur over the span of several months (Lawlor, 2013; Merlin-Knoblick et al., 2018; Rankine, 2017). However, in-person trainings can be difficult for some due to location and scheduling. To address the needs of helping professionals in remote areas with limited temporal availability, Swank and Tyson (2012) discussed an asynchronous, internet-based training program for school counselors. The six modules covered the following topics: “(a) introduction to the counselor education program; (b) expectations and requirements; (c) supervisor and trainee characteristics and the supervisory relationship; (d) supervision models, stages, and theories; (e) supervision methods and techniques; and (f) ethical and legal dilemmas” (Swank & Tyson, 2012, p. 43). Upon completion of the modules, the school counselors completed a quiz to assess learning, and received continuing education credits and a certificate of completion. The COVID-19 pandemic further highlighted the need for remote supervision options, especially when working with high-risk clientele, and given the increase in suicidality due to the pandemic’s socioemotional and economic toll (Hausman, et al., 2021).
Purpose of the Present Study
The purpose of this study was to determine whether an asynchronous online training program for clinical supervisors impacted the supervisory working alliance for supervisors and trainees during social work and counseling fieldwork placement. Although the training program was created prior to the COVID-19 pandemic, an examination of the effectiveness of this program may assist in the creation of future training models using a remote format. Online trainings not only assist busy professionals and those who live in rural areas (Swank & Tyson, 2012), but also ensure training content continuity during times when in-person trainings are not optimal. Additionally, the study examined various demographic variables of the supervisor (i.e., years of experience, number of trainees, and type of training) and trainee (i.e., gender, race, age, and program of study) to determine whether they were related to the supervisory working alliance.
Research Questions
This study aims to answer two questions about this supervision training program: (1) Does reflective supervision training result in improved Supervisory Working Alliance Inventory (SWAI) scores for supervisors and for trainees from pretest to posttest? and (2) What specific supervisor and trainee characteristics are related to SWAI scores?
Methods
Research Design and Recruitment
The research design employed a pre- and postprogram evaluation with both students and supervisors. Study participants were participating in a training program funded by a Health Resources and Services Administration (HRSA) Behavioral Health Workforce, Education, and Training (BHWET) program. Students were recruited for the training program via email outreach by the directors of the social work and counseling programs at a large urban university in a southeastern region of the United States. Students applied for participation in the training program and were competitively selected for the program, as limited spaces were available. For the training program, students were required to be in the final year of their master’s program in social work or counseling, and to be interning in a setting that included integrated behavioral health. Student trainees were paired with supervisors who participated in the reflective supervision training. If site supervisors chose not to participate in the training program, doctoral students or university faculty were given the opportunity to serve as the student’s supervisor and participate in the study. The evaluation of the training program was reviewed and approved by the University IRB.
Participants
A total of 43 trainee-participants completed fieldwork requirements in master’s degree programs in social work (n = 22) and counseling (n = 21), and 36 site supervisor participants were recruited and participated in the present study. Twenty of the supervisors had academic degrees in counseling, and 16 of them had academic degrees in social work. Trainee participants received $10,000 for participating in six months of supervision and training, completing assignments, and pre-/posttests. Site supervisor participants received $1,500 for participation in training modules, assignments, and pre-/posttests. See Tables 1 and 2 for supervisor and student demographics.
Table 1
Demographics and Descriptive Statistics for Trainees (n = 43)
| Variable | Percentage (Mean) |
| Program of study Counseling | 48.8 51.2 |
| Enrollment Full-time | 74.4 25.6 |
| Trainee age Under 25 | 18.6 53.4 14.0 14.0 |
| Trainee sex Male | 11.6 88.4 |
| Trainee race Black | 37.2 58.1 4.7 |
| Supervisor Working Alliance pretest | (5.25)* |
| Supervisor Working Alliance posttest | (6.16)* |
* Items varied from 1 = “Almost Never” to 7 = “Almost Always”
Table 2
Demographics and Descriptive Statistics for Supervisors (n = 36)
| Variable | Percentage (Mean) |
| Discipline Counseling | 55.6 44.4 |
| Number of students supervised One | 83.3 16.7 |
| Training completed Basic only | 86.1 13.9 |
| Number of years supervisor One | 86.1 13.9 |
| Supervisor Working Alliance pretest | (5.70)* |
| Supervisor Working Alliance posttest | (6.14)* |
| Course helped me make more informed decisions in supervision | (6.38)** |
| Course was well-organized | (6.47)** |
| Reflective writings helped me develop supervisor skills | (5.88)** |
| Readings helped me develop supervisor skills | (6.56)** |
| This course will change my supervisory behavior | (6.21)** |
| The course material will be useful to me in the future | (6.56)** |
| I will share what I learned with colleagues | (6.35)** |
| Overall, how satisfied? | (4.44)*** |
* Items varied from 1 = “Almost Never” to 7 = “Almost Always”
** Items varied from 1 = “Strongly Disagree” to 7 = “Strongly Agree”
*** Item varied from 1 = “Poor” to 5 = “Excellent”
Program Model: Structure and Themes
Supervisors were asked to participate in an asynchronous web course designed to prepare field instructors/supervisors to provide educational and reflective supervision to social work and counseling students. The previously reviewed literature served as the foundation for the development of two reflective supervision courses: an introductory course for supervisors participating in the study for the first time, and an advanced course for returning supervisors. Each course focused on six topical areas, divided into modules. Supervisors were given approximately 10 weeks to complete their respective courses, during which time they were supervising a trainee. All modules were connected to assignments that allowed the supervisors to reflect and apply the skills learned.
In addition, supervisors were asked to complete pre- and posttests relating to the course. Both supervisors and trainees completed a measure that focused on the relationship in supervision as perceived by the supervisor. Supervisors who completed all pre- and posttests and completed at least 80% of the written activities of the course received full monetary compensation and six continuing education units (CEUs) at the end of each cohort.
Introductory Basic Course
The introductory course focused on the following six modules: (1) overview of supervision, (2) supervisor styles and stages of intern development, (3) promoting critical thinking and self-reflection through teaching and modeling, (4) ethics, (5) addressing concerns in supervision, and (6) assessing growth and development. Each module contained a PowerPoint presentation that corresponded to its topic, with voice narration. In addition, supervisors read articles focused on the guiding principles of clinical supervision, mentoring, and teaching; promoting self-efficacy; assessing growth; and managing difficulties in supervision. Upon beginning the course, supervisors completed a measure focused on the supervision relationship as perceived by the supervisor.
Supervisors submitted three short written reflection assignments. In the first assignment, supervisors were asked to establish a supervisory timeline in which they reflected on their history as a trainee and preparation to become a supervisor. In the second assignment, supervisors were asked to reflect upon how their experience as a trainee shaped their practice as a supervisor. In the final assignment, supervisors were asked to reflect upon how their supervision has changed over time and any content from the course they will incorporate into their current and future supervisory relationships.
Advanced Course
The advanced course was developed for supervisors who had previously participated in the supervision training, and had thus completed the basic course. The course consisted of particular topics related to supervision, and focused on the following six modules: (1) approaches to supervision, (2) working through ethical issues with students, (3) telesupervision, (4) vicarious trauma and wellness, (5) addressing race and culture in supervision, and (6) termination of the supervisory relationship. Supervisors read articles that corresponded to the modules. The readings were chosen to assist supervisors with creating and applying an educational framework to student supervision.
Supervisors in the advanced course submitted six short written assignments meant to further/deepen self-awareness and insight related to supervision:
- In the first assignment, supervisors were asked to reflect upon challenges experienced in supervision and how they navigated them.
- The second assignment asked the supervisors to reflect upon how they have assisted students with ethical processing challenges during fieldwork.
- The third assignment called for the supervisors to share their perspectives on telesupervision during the COVID-19 pandemic.
- The fourth assignment asked supervisors to reflect upon ways to utilize wellness as a mitigating factor for vicarious trauma in the supervision of their trainees.
- The fifth assignment asked supervisors to reflect upon how they have addressed and processed race and racial trauma in their supervision and supervision with trainees.
- The sixth and final assignment called for supervisors to explore and share challenges and triumphs experienced during the termination of the supervisory relationship.
Instruments
Four questionnaires were included in the analyses. One instrument was created to gather sociodemographic and descriptive data. Another was designed to assess supervisors’ perception of their satisfaction with the course. Two validated instruments were used to assess the SWA; specifically, these were two forms from the Supervisor Working Alliance Inventory (SWAI): the Supervisor Form (SWAI–Supervisor) and the Trainee Form (SWAI–Trainee) (Efstation, et al., 1990). The SWAI–Supervisor had 23 items, and the SWAI–Trainee had 19 items. As previously stated, the SWAI–Supervisor included three subscales (Client Focus, Rapport, and Identification), and the SWAI–Trainee included two subscales (Client Focus and Rapport). Items were designed on a seven-point Likert scale, with anchors 1 (Almost Never) and 7 (Almost Always). These subscales demonstrated good internal consistency reliability (Cronbach’s alpha = .71 for Supervisor Client Focus, .73 for Supervisor Rapport, .and 77 for Supervisor Identification; .90 for Trainee Rapport, and .77 for Trainee Client Focus). In the present study, the supervisor form had an overall internal consistency reliability of .91, and the trainee form had an overall internal consistency reliability of .99. (See the Appendix for sample questions).
Data Collection
All supervisors’ and trainees’ sociodemographic and SWAI data were collected via Qualtrics. Sociodemographic and descriptive statistical data were gathered upon beginning the training year. Trainees completed the SWAI–Trainee measure at pre- and posttest, prior to the start of their placement and at the end of the placement. Whether beginning the introductory basic course or advanced course, all supervisors completed a measure focusing on the relationship in supervision as perceived by the supervisor (i.e., SWAI–Supervisor) at pre- and posttest, prior to starting the supervision course and upon completion. Additionally, all supervisors completed a course satisfaction survey upon completion.
Data Analysis
Data were imported into SPSS version 27 for analysis. Descriptive statistics were examined to ensure no violations to the assumptions of skewness and kurtosis. To address the first research question (i.e., whether Reflective Supervision training improved SWAI scores for supervisors and trainees), paired samples t-tests were employed to examine the pre- and postchange in SWAI scores for supervisors and trainees separately. To address the second research question (i.e., what supervisor and trainee characteristics are related to SWAI scores), various statistical approaches were employed. Independent samples t-tests were used to compare SWAI scores at pre- and posttest by type of supervisor training (basic, advanced), number of years as a supervisor, number of students supervised, trainee gender, trainee program of study (counseling vs. social work), and trainee enrollment (full- vs. part-time). One-way analysis of variance (ANOVA) was used to examine the relationship between trainee race and SWAI. Bivariate correlations were used to assess the relationship between SWAI–Supervisor and SWAI–Trainee scores, and the relationship between trainee age and SWAI scores.
Supervisors and trainees could not be considered as dyads because many of the supervisors had more than one trainee. Therefore, to look at the relationship between supervisor and trainee scores, we used supervisor score as an independent variable and trainee score as a dependent variable in the multivariate analysis. Due to the small sample size, we limited our use of multivariate analysis to only two predictor variables (Siddiqui, 2013) since small sample sizes reduce power, thereby increasing the margin of error. Specifically, we used a repeated measures multivariate analysis of variance (MANOVA) of SWAI–Trainee, with a predictor variable of number of years (Time 1, Time 2) as a supervisor and time of measurement.
Results
Supervisors (n = 36) and students (n = 43) completed the programming, which consisted of reflective supervision training for the supervisors and interdisciplinary training focused on integrated behavioral health for the trainees. Supervisors and trainees worked together over the course of an academic year in the field setting. Thirty of the supervisors worked only with one student during the program, and six worked with two or more students. Thirty-one supervisors completed the basic training in reflective supervision, and five completed both the basic and advanced trainings. See Table 1 for trainees’ and Table 2 for supervisors’ sociodemographic and descriptive statistics.
Supervisors gave very positive feedback in response to the reflective supervision training. On a seven-point scale with 1 = “Strongly Disagree” and 7 = “Strongly Agree,” supervisors rated the training from 5.88 on “reflective writings helped develop my skills as a supervisor” to 6.56 on both “readings helped me develop my supervision skills” and “course materials will be useful to me in the future.” On a five-point scale with 1 = “Poor” and 5 = “Excellent,” supervisors rated their overall satisfaction with the training at 4.44. See Table 2 for more information about supervisor satisfaction with the training.
A paired samples t-test indicated that trainees had significantly higher SWAI scores at posttest than at pretest (t = –3.20, df = 40, p = .003). Similarly, supervisors experienced significant growth in their SWAI scores from pretest to posttest (t = –4.456, df = 32, p < .001). No correlation emerged between supervisor and trainee scores on the SWAI at either pretest (r = .18, p = .264) or at posttest (r = .10, p = .524). Comparing supervisors by discipline, counseling supervisors had higher SWAI scores than social work supervisors at pretest (t = –2.47, df = 34, p = .019); however, there was no difference by discipline at posttest (t = –1.61, df = 31, p = .117).
No significant differences were found in participants by trainee program of study, type of enrollment (full- or part-time), gender, age, or race. The bivariate relationship between number of years as a supervisor and SWAI–Trainee posttest was significant in the opposite direction than expected (r = –.33, p = .032). In other words, trainees had a better working alliance with supervisors who had less experience with supervision.
Means and standard deviations for the SWAI–Supervisor scores overall and for each discipline are reported in Table 2. Supervisor pretest scores were compared by type of training the supervisor completed (basic vs. advanced), number of years serving as a supervisor, and number of students supervised, using independent samples t-tests. No significant differences were found by any of these variables. The repeated measures MANOVA indicated significant growth in trainee SWAI scores, but the effect size was small (F = 6.12, df = 1, p = .018, partial ɳ2 = .136). The significant relationship between number of years supervising and trainee SWAI posttest score remained in the multivariate analysis, but again, the effect size was small (F = 4.84, df = 1, p = .034, partial ɳ2 = .111). See Table 3 for the full results of the repeated measures MANOVA.
Table 3
Repeated Measures MANOVA of Supervisory Working Alliance–Trainee (n = 43)
| Tests | F | df | p | Partial ɳ2 |
| Multivariate tests within subjects Levels | 6.12 4.85 | 1 1 | .018* .034* | .136 .111 |
| Univariate tests within subjects SWAI student posttest | 6.12 4.85 | 1 1 | .018* .034* | .136 .111 |
*Significant with α at .05
Discussion
Overall, supervisors had a positive response to the reflective supervision training. Supervisors reported feeling that the curriculum helped them develop their skills and provided them with resources for future application. Additionally, several supervisors reported that they shared the training materials with other supervisors at their employment site, increasing the reach of the study, although additional data could not be obtained. Formal training programs for supervisors lead to improved preparedness, self-awareness, enhanced supervisory relationships, and having a more supportive approach to the supervision of trainees (Gazzola et al., 2013; Kemer et al., 2019; O’Donovan et al., 2016; Ybrandt & Armelius, 2009). Utilizing an asynchronous virtual format for supervisor training allows supervisors to participate when a scheduled in-person meeting may conflict with location or time constraints (Swank & Tyson, 2012).
Although there was no correlation between supervisor and trainee scores on the SWAI at either pre- or posttest, scores on the instrument improved from pre- to posttest for both groups. Furthermore, overall growth among the supervisory working alliance was perceived by both supervisors and trainees. These data provide support to the value of training programs for the supervisors of clinical fieldwork trainees (O’Donovan et al., 2016; Park et al., 2019).
There was no significant relationship found between Trainee–SWAI posttest scores and supervisor’s level of training (basic vs. advanced) or the number of students supervised. Trainees had a better working alliance with supervisors who had less experience with supervision. This discovery may be attributed to beginning supervisors’ transferring their practice skills to their supervisory experience with trainees to develop a rapport (Kemer et al., 2019). This finding supports a study by Stevens et al. (1998), which found that experience alone is not sufficient to enhance a supervisor’s development. Formal training is integral to the comprehensive development of the supervisory relationship.
Limitations
This study has some limitations that should be noted. First, the study had a small sample size of trainees and supervisors. Secord, there were more trainees in the sample (n = 43) than supervisors (n = 36). As a result, some of the supervisors provided supervision to more than one trainee, so there were not distinct dyads. Third, the trainees included in this study were not diverse in terms of ethnicity and age. Lastly, this study did not find a correlation among variables between supervisor scores and trainee scores, impacting its ability to contribute to implications on outcome variables.
Practice Implications and Recommendations
Given the limitations of the study, replication and extension of this work are necessary. Future studies should include a larger, more diverse sample. A larger study might reveal differences relating to demographics, practice experience, supervision experience, or prior/current training. Additionally, limiting supervisors to one trainee would create dyads that could be analyzed. Evaluating the relationships between these variables would contribute to the current supervisory alliance and supervision process research.
Despite limitations related to sample size and outcomes, this study contributes to the literature by supporting the establishment of and participation in a formal training program for supervisors. In addition, this study describes two asynchronous virtual training models that can train newer or advanced supervisors to develop a framework that supports a positive supervisory experience for their trainees. An ongoing review of the literature may provide the relevant content for the training programs to ensure that the materials meet the needs of the supervisors as well as the trainees.
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Appendix: Sample Questions
Instructions: Please indicate the frequency with which the behavior described in each of the following items seems characteristic of your work with your supervisor. After each item, circle the number corresponding to the appropriate point of the following seven-point scale.
Supervisor Working Alliance Inventory (SWAI)–Trainee Form
1) I feel comfortable working with my supervisor.
4) My supervisor encourages me to talk about my work with clients in a way that are comfortable for me.
10) I feel free to mention to my supervisor any troublesome feelings I might have about him/her.
16) When correcting my errors with a client my supervisor offers alternative ways of intervening with the client.
19) I work with my supervisor on specific goals in the supervisory session.
Supervisory Working Alliance Inventory (SWAI)–Supervisor Form
5) In supervision, I expect my supervisee to think about or reflect on my comments to him/her.
7) In supervision, I place a high priority on our understanding the clients’ perspective.
14) I make an effort to understand my supervisee.
18) My supervisee appears to be comfortable working with me.
20) During supervision, my supervisee seems able to stand back and reflect on what I am saying to him/her.
From Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37, 322–329.